After a final early morning run, readying myself for homeward-bound adventures…

The final Sessions of the 2010 mHealth Summit…

Dr Julio Frenk, Dean of the Faculty, Harvard School of Public Health

kicked off the day – and said we must stop the ‘idea that poor people deserve poor services’; she called that we replace the idea of health centres with ‘health spaces’ bringing connectivity via clinics to the home or on the move..

She called upon ‘software, hardware, but also humanware’, as health is also tied up in our national security, economy and environment, and also asked everyone to imagine a world without ‘mobile phones’ – with the central tenet of voice – but a world of screens where health and other services were adopted.

But privacy and security are key – they can provide confidence in a HIV sufferer to send an SMS anonymously, but also may restrict innovation. It is a fine balance. The idea of risk and benefit may need to be re-defined from our ‘cotton wall’ era though.

A good analogy was made by Col Ronald Poropatich, Deputy Director, Telemedicine, US Army Medical Research–

people knew the risks of the car, or the two-pronged electric plug, but they decided the benefits outweighed the risks and went for it. Maybe a leap of faith also needs to be taken in this revolution. And TRUST should be the currency which keeps up with technology quicker than regulations.

MEDICAL ID THEFT – the ID number issue was discussed; can 1 digit be added to existing Government issued numbers? Would people accept this or even remember it?? If there is fraud, this could end up being fatal ie. someone receiving the wrong blood type in a transfusion.

Rob McCray, President and CEO, West-Wireless Life Sciences Alliance, rounded off the 2010 mHealth Summit by stating the current healthcare system: ‘ is as opaque as the financial services industry, but not as profitable. It is equivalent to the 1970s automobile industry – expensive, inefficient and twice as much spend as the developing world but with half the return in terms of reduced or halted chronic illness deaths.’

So lots to be done, and some final food for thought as I round up this review

“The cell phone is not a panacea for health care” Bill Gates

or

‘The best way to fight poverty is to give someone a cell phone’ Nobel Peace Prize Laureate Muhammad Yunus

The big day today – Mr Bill Gates is going to pop along for lunch at the summit. Any former bleats of Apple and the iphone within the industry mysteriously go out the window: with the NHS as Microsoft’s 3rd biggest client in the world, the standing of Mr Gates in health still rings true….

David Aylward, Executive Director, mHealth Alliance again opened up the morning – first by showcasing software company Zephyr-Technology’s remote heart sensor bravely on screen so that the mhealth influencers could ruminate on his cardiovascular situ in detail. He re-iterated the need for health change:

360,000 women die every year on the reference of ‘bad data’

4 million children die before they reach 30 years old

The Millenium Development Goals are going some way towards rectifying this – we heard in September of how the Nigerian Government are working with Intel to realise some of the goals though wireless healthcare. But as Aylward said we now rightly demand ‘more health for the money’; mobile healthcare can start to deliver some of the breadth of service and cost savings necessary.

Ted Turner, Chairman, United Nations Foundation

Truly, A LEGEND

One of the keynote guests of the day was former husband of Jane Fonda, Founder of CNN Network, Cartoon Network, Turner Broadcasting, and Chairman, United Nations Foundation, Ted Turner. I was not previously aware of the gravitas of Mr Turner’s standing – he was a brilliant asset to showcase the arrival of mhealth.

Much though moderator Tom Wheeler tried to get back Ted onto ‘Health’ the main advice was on stopping war – ‘shooting someone or bombing them is not good for their health’!

Other Ted Turner Advice for Those in M-Health:

How to get on as a start-up …‘Early to bed, early to rise, work like hell and advertise.’

Challenges? ‘Whenever I hit an obstacle, I tried to get around it, around it, under it or over it!’

He personally doesn’t watch more than 1/2 hour of television a day, doesn’t read novels only books of industry focus and The Economist from cover to cover.

Customer Service ‘You always do better if your customer likes you,… and your wife and your husband. Be nice! Be nice!’

Lessons Learned Around the Globe

Thierry Zylberberg, Executive Vice President, Orange –

speaking in 2010 at the MHIS, London

Thierry stated how mobile health in mature markets meant efficiences; mobile health in growth or developing markets means pure access to services and these different perspectives must be respected -Note: you cannot apply a mature market model to a regionally specific market. FACT: A recent Price Waterhouse Cooper report stated that 42% of Americans would pay for a remote monitoring service

Alex Ibasco, CIO, Smart Communications, Phillipines agreed –

his multi millions network subscribers suffer 20 typhoons a year, but only spend 4$ a month on airtime – the Government however is keen to divert TB, Malaria and Dengue Fever and manage cases so the care-givers or Government pay for m-health, creating a sustainable business model outside of the 4$month subscriber.

‘We are the electronic glue connecting the value systems in the m-health ecosystem’ With 50% of filippinos born without a doctor or midwife and the nation spread across 7,000 islands, mhealth is working in the same way as the existing m payments infrastructure to allow payments to go direct to the patient via the NGO or micro-financier.’

Thierry, Orange seemed to agree with this enabler model of the operator: [the operator] ‘takes information from here and puts it there and maybe stores it in the middle’; end-to-end services are destined to failure as you can’t be all things.’

2. THERE IS NOT A KILLER APP – there are multiple solutions for multiple scenarios

3. RECYCLE, RE-USE, RE-PURPOSE – share with others, don’t re-invent the wheel. Collaboration is much more fun than competition.

4. SYSTEMS – leverage a systems thinking approach throughout. What is the impact further down the chain?

5. DEVELOP WITH LOCALS

6. PARTICIPATORY DESIGN PROCESS – make sure the end user is involved in design and change management

7. BE REALISTIC

8. ACCOUNTABILITY – set targets and benchmarks, lives are involved and accountability is key.

9. LOCALLY GENERATED CONTENT – make it local!

10. EVALUATE – you must unlock pathways to change that have been reasoned.

NOT A FAD – 30% of consumers in McKinsey study would pay $2 for a 10 minute consultation. That’s 10x rev. of base telecoms minutes.

NOT A GAME – this will have disruptive impacts to standard business models and impacts on lives

NOT JUST ABOUT CARE DELIVERY – will also change insurer communication with consumers over mobile

NOT A NICHE BUSINESS – ‘mobility’ is transforming a number of business’ – energy, retail, and banking (good news for our smart cities event in Dubai then – ask me if you are interested!)…

ABOUT REACH OF CARE – but dollars are certainly in the mature markets which have massive spend in this area.

1:50 doctor to patient ration in developing markets

1:2 mobile penetration in same markets

I briefly was distracted by this moustached young gentleman:

Spiffing!

and then it was time for the BILL GATES LUNCHEON!!

Ask: 'What is the key metric you are trying to improve.'?

Comfortably sat, and apparently oblivious to the geeky scramble to get to the front, Bill Gates espounded a view of mobile healthcare as a tool to bring down some of the key health issue metrics in the world: ‘It is our mission to bring computer technology to some of the global issues’ He referenced how pharma antiviral drugs and vaccines had helped cancel out small pox and reduce the ravages of other diseases but ‘in the case of the cell phone, there is a chance to go beyond that, and to be with the patient.’

What we must ask ourselves is ‘What is the key metric you are trying to improve.’?

He asked while vaccines are doing so well, how do cell phones fit in? By registering every person at birth the following was enabled:

1. Patient Reminders – take TB drugs regularly

2. Supply Chain – what’s available and taking fraudulent drugs out of the chain

3. EHR and birth registration

﻿‘We should let 1000 ideas blossom, but work to key metrics – can we drop diarrhoea by 1/2? etc etc’

With more Bill and Melinda Gates grants of $2m upwards towards this area he was particularly encouraged by movements in diagnostics: ‘we are seeing a lot of great things’ coming through’.

Though he praised the beauties of capitalism he said that its downfall was research, which had a systemic failure only to be met by Government intervention. With Capitalism ‘the means of the poorest are not met by human guise’; The Gates’ Foundation went some way to fill this research gap.

The 6bn-9bn population growth will not be in urban cities but in urban slums, putting new pressures on housing, education, sanitation – ironically, the countries with high population are unhealthy, but those with a healthy population have low population growth and plateau out – disproving the idea that helping the under 5s who may otherwise die will lead to further resource depletion and stress, but will actually enact the opposite.

‘There will be no trees,animals, jobs, or schools at 3% population growth -no one can handle that.’

He mentioned that with Economic recession aid had lessened and his role was now international beggar of monies. The most sentient point I found was his approach to different regions, not developing and developed but

Low Income

Middle Income

Rich Income

with China, Brazil and South Africa among the Middle Income countries who are now leading technology and innovation. Whilst the rich countries’ approach to healthcare is conservative, regulated, and without a reimbursement model. He stated that for best health global improvements we should go for the middle income countries, as there are some potential end-users of the US who will not exercise whatever incentive is laid out, and he warned against going after this super narrow market but instead attacking the wide breadth of new middle income countries.

Asked about the future he said ‘it’s got to be robots’!

Whilst dexterity technology is 5 years out, ambulatory connected services had far advanced and robotic c-sections might be a possibility. Robotic aids could help the elderly to the toilet, which led me to question if this fitted in with a patient-centric model of health innovation or one of metallic misunderstanding and loneliness??

Finally, he wrapped up by suggesting that mobile and computing may help stem the dip in drug discovery by computing this process and that what ever health innovation occurs,

‘if we’re smart about it , it will benefit the poor as well as the rich.’

Aneesh Chopra, US CTO, White House

Another great techy from the White House – I’m pretty sure he said dude a number of times and he was buzzing with excitement/delerium having come back the night previously from Obama’s world tour. He spoke about Barack Obama’s own personal belief in using technology to gain better health outcomes and used the example of a Maternal Health application in a ‘wired village’ in India. He stressed the importance of a new RESULTS DRIVEN ECOSYSTEM won by adding public participation to achieve:

I’ve just got back from a research trip to the 2010 mHealth Summit Washington DC. Unfortunately, Obama was out of town in Indonesia and South Korea, but I managed to enjoy a glimpse of his ‘grounds’ during a couple of early morning runs…

The 2010 mHealth summit – produced and presented by the Foundation for the National Institutes of Health in partnership with the mHealth Alliance and the National Institutes of Health – set a noble tone for the mobile healthcare movement. Scott E Campbell, Executive Director and CEO, Foundation for NIH and David Aylward, Executive Director, mHealth Alliance, introduced the event in celebratory style congratulating the culture of collaboration prevalent in mhealth. They announced anideas sharing forum in the HUB – healthcareunbound.org where people can register and reach out to one another avoiding the common mistake of ‘re-inventing the wheel’ in this unchartered territory of technological and healthcare innovation in it’s most exciting and fruitful time.

In addition to the GSMA as a new mHealth Alliance member, Hewlett Packard signalled a shift in membership – it has just signed as a new member to the mHealth alliance in a two year, $1 million aggregate donation to help improve health care and health systems. mHealth is now beyond mobile operators and NGOs and has entered the realm of the big systems integrators, computing powers and the cloud.

Other symbols towards mHealth uptake include an increase in mobile phone related projects by the NIH, with $36 million allocated in 2009.

Todd Park gave a fantastic keynote , delivered with electric energy and excitement on the potential of mobile in health. He set the tone by mentioning Text4Baby – a 3 year SMS reminder and prompting service for new mums in the US, and the largest m Health service in the US with other a 100,ooo subs and rising following its launch only this year.

Text4Baby received a lot of attention throughout the event – it functions as a collaborative model with all CTIA carriers, and a multitude of maternal private clincs working together to provide the free service. It captures the imagination because people can relate to it, it is a simple service, but with direct hopeful behavioural changes for both mothers and the ongoing healthiness of the newborns having been given the best start.

Park went on to tackle the current unsustainable measurement of healthcare provisioning in the US – based on volume of patients seen, rather than the inherent value of health treatment provided – in terms of the patient health improvement and to the overall system in limiting re-admissions. Incentivising financial systems is key and I was hard pushed to find someone who thought that the removal of the 30days obligatory cover for re-admissions, now paid for by the hospital/State, was a bad thing – as it suddenly puts a real financial incentive on administering care with a long tail view.

Next was data liberacion! Park’s open health data campaign which sets up free online data and total IP ownership of this data, so that those who – Important! – opt in, can allow third parties to develop innovative solutions around this data. One example being the Blue Button Veteran scheme which allows veterans to access their PHR’s easily and intuitively. This scheme was decided upon and rolled out in less than a year, perhaps disproving the groans that regulatory frameworks and approvals are stagnating product development in the longer 5-10 year framework. One can’t help thinking that these systems must now be put in place, so that the patient has a choice between ‘public’ open data platforms for PHRs and those from Google and Microsoft becoming the standard…..thoughts on this?

Next up was a panel discussion on Cross-Sectoral Perspectives on MHealth

set it straight when he immediately discharged the idea of developing and developed health markets and economies, stating that India is one of the highest growing markets globally with a 7% healthcare tourist penetration. It did seem apparent that ‘developing’ ‘developed’ was still in terminology much more in the US discussion than in European events, and when one astute audience commentator asked whether the introduction of smartphones in mature markets would make obsolete feature-phone handsets (which have helped to put health in the hands of those less fortunate) many speakers seemed at a loss.

Sanjay Kaul, Business Unit Multimedia, Ericsson put a commercial spin on things when he stressed the need to find sustainable business models (one of the key themes of the event) making mobile healthcare more than pure philanthropy or CSR.

David H Gustafson, Director, Center for Health Enhancement Systems, University of Wisconsin was pure joy providing sentient and sensical soundbytes and humour throughout a sometimes misguided panel – someone at his age, 234 he said!, had difficulties with touch screens because of shakes, or keys, because of vision impairment – UI at source is key to improving this. (The exact sentiment reached this side of the Atlantic in September at our Industry Summit). Iconic languages can help where illiteracy is a consideration, and greater education of new systems – including getting physicians involved in work flow changes – is integral to success.

Futhermore trust needs to be established – will this device do me good or do me harm? How can we stamp approve medical apps? And if networks are going to take on this service – with medical sensitivities – then perhaps the service obligations of the carrier is suddenly entirely different and includes safeguarding of life inherently?

After a spot of crab cakes for lunch with a dear MVNO associate nearby, I stopped at another panel discussion on

The Business and Economics of mHealth – something central to us all.

Patient-Centric Models are the buzz word, but what does that mean? Well apparently to the panel:

1. To help people live a healthy life – wellness and prevention

2. To help people get healthy and recover

3. To help people exist with a chronic illness

Frederic Zussa, Director, Worldwide Strategy and Innovation at Pfizer said that the power of ICT should be to increase productivity of healthcare, and that technology should not be siloed as a barrier to this.

Peter Drury, Director, Health and Development, Emerging Markets, Cisco agreed identifying the problem of healthcare as Siloes, Systems and States – with disruptive innovations like m Health going a long way to opening up the market to the disenfranchised in the same way as mPayments has done in Kenya.

First Day Summary:

‘Global is not the opposite of domestic.’

Trust is essential

How to get clinical tests to commercial reality quickly?

Getting to Scale

Achieving Sustainable Business Models

Patient Centric Models

Does mHealth prolong poor life quality for the disenfranchised and the Chronic?

Apologies it’s been too long! Following our 2nd Annual Mobile Healthcare Industry Summit – check out some great reviews and analysis here…Salina Christmas at Clinica did a great job of putting down the main developments and taking her usual documentary photographs on site, and further insights are recored at media partners mobihealthnews.com, telecoms.com and 3G Doctor.

There’s a tangible sense that 2011 will see pilots sitting in clinical trial phase moving into commercial launches, with certifications and new partnership announcements. That’s why we have started to roll out our series in two phases: Firstly, into the investment pot of Dubai and the Middle East, some areas of which show great advancement in this marrage area of technology and healthcare provisioning.

Next – we are also aware there is a need for continual networking and business development opportunity in this nascent and exiting industry so have started our mobile healthcare review afternoons and evenings to allow you to meet up with those people who were at the September annual event before awaiting another year. Our first one kicks off on the 14th December, 3pm-8pm at the Kings Fund, London and we have a very exciting agenda lined up for just £99. We look forward to welcoming you along. And opportunities are still available for a drinks sponsor at this networking event if you are an EU/UK business interested please contact sophie.powell@informa.com….we’ll make sure you are first of the queue for a drink in return, I promise!

Now turning to 2011 – I am excited to announce another review day taking place on the 26th March at the Royal Society of London, in partnership with London First and Harley St Alliance. If you are interested in taking part, we are now in our planning phase so feel free to get in touch at the same address as above.

Our annual event returns in the last week of September, with a potential new European city destination to be announced. I have just returned from the US – the m Health Summit in Washington DC – with some new keynote speakers lined up from the US healthcare insurer ‘payer’ sector, as well as some of the more commercial launch case studies from the US.

Excitingly in 2011 we will be co-locating with the fast moving European mHealth Alliance (EuMHA) who have rapidly accumulated cross-disciplinary and cross-sector members working on mobile Health collaboration in innovation, research and more. Some announcements on that coming soon! We look forward to bringing a continued forum of Mobile Healthcare innovation and advance to you in 2011 in collaboration with our partners and colleagues….now for a round up of the M Health Summit and main news from the States….

The results of our mHealth Market Research Survey – which attracted the participation of over 1800 mHealth and Wireless Healthcare experts – are now in, helping us take the pulse on this industry for the very first time:

Chart 1: How Long Respondents Have Been Working With mHealth and Wireless Health Services The responses show that despite the general economic gloom this is an industry full of optimism of rapid adoption and growth. By 2015:

> 75% felt mHealth solutions would be widely accepted and used in Healthcare
> 72% felt that most health insurers will be offering mHealth solutions
> 61% felt mHealth services will be widely accepted by patients

Some key lessons also emerged:

> The importance of design: 64% of respondents indicating that by 2015 digital engagement would prove to be the most popular way to bring new mHealth solutions to market, what better time to sign up to the Design specific panel discussion at 12.15pm on day II with Frog Design and more to provide you with a toolkit to structure your company’s mHealth products and services around the needs and desires of those that will ultimately use them.

> Confidence in the success of low cost devices: With nearly 58% of respondents indicating their confidence in low cost (eg. <$50) solutions dominating the 2015 mHealth market there will be enormous potential for serving patients in emerging markets. Hear from companies that are creating these transformational new products in the University Mobile Healthcare Challenge and join Dr Ruchi Dass for our Keynote interview on Day IIwhere there will be an overview of the emerging market healthcare landscape and opportunities.

> Importance of Clinician/Provider adoption: with 62% of respondents indicating that this will be the number 1 driver of mHealth adoption make sure you’ve brought plenty of business cards as this year the event is free to attend for practicing clinicians and we’ve just confirmed that there will be another 20+ leading clinicians joining us as a result of a collaboration with the Telemedicine & eHealth section at the Royal Society of Medicine, with healthcare provider registrations have been unprecedented. And then there is the invite only Harley Street World evening workshop.

‘Cloud Services will be a Natural Thing for Operators to Offer’ – so said, Fernando Nunez Mendoza, Co-Founder , President and CEO, fonYou Spain. The fascinating MVNO and its visionary leader always present in ways to make you think – this time around they are really stressing the need for operators to play internet tigers at their own game and open up. Mendoza stated that online telephony (cloud) will be as ubiquitous as e-banking when it simply became ‘banking’. Think they may be on to something myself.